High-dose vitamin C management in dapsone-induced methemoglobinemia

Park, Sin-Youl; Lee, Kyung-Woo; Kang, Tae-Sin

doi:10.1016/j.ajem.2013.11.036

Cited by 40 publications

(34 citation statements)

References 8 publications

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“…Studies on vitamin E have found no effect [26] or a partial protective effect when 800 units were administered for 4 weeks [27]. Studies on vitamin C doses that are >1 m M (attainable by intravenous administration) have found methemoglobinemia reduction; however, oral administration cannot exceed 200 µ M because of the gastrointestinal absorption [28,29,30]. Studies on the cytochrome P450 inhibitor cimetidine in rats and small studies on humans have found that concurrent administration reduces levels of methemoglobinemia [31,32].…”

Section: Discussionmentioning

confidence: 99%

Dapsone Therapy for Pustular Psoriasis: Case Series and Review of the Literature

Sheu¹,

Divito²,

Enamandram³

et al. 2015

Dermatology

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Background: Pustular psoriasis is an uncommon psoriasis variant, clinically characterized as small sterile pustules on an erythematous base. Evidence for therapy is lacking, and many currently employed systemic therapeutics carry risks of significant side effects, without specifically targeting disease etiology which includes the aggregation of neutrophils. Observations: We report therapy with the anti-neutrophil agent dapsone in 5 patients with pustular psoriasis and provide a brief review of the literature. Four patients responded to oral dapsone and 1 to topical dapsone therapy. All 5 patients had previously failed multiple topical and systemic treatments. In 2 cases, oral dapsone allowed for the discontinuation of other systemic agents. One patient stopped oral dapsone due to a side effect of sleep disturbance. Conclusion: Dapsone has a much safer side effect profile and may target the pathophysiology of pustular psoriasis more directly than many other systemic agents. As such, dapsone should be considered for the treatment of patients with pustular psoriasis.

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Section: Discussionmentioning

confidence: 99%

Dapsone Therapy for Pustular Psoriasis: Case Series and Review of the Literature

Sheu¹,

Divito²,

Enamandram³

et al. 2015

Dermatology

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“…Numerous in vitro studies have shown that ascorbic acid (vitamin C) can treat methaemoglobinaemia by removing key precursors of oxidative damage and reducing methaemoglobin 26. In a case report from Korea, Park and Lee described the use of high-dose intravenous ascorbic acid (10 g four times a day) for the treatment of methaemoglobinaemia (due to non-availability of methylene blue) 27. However, in the case reported by Park and Lee, the patient did not have G6PD deficiency.…”

Section: Discussionmentioning

confidence: 99%

Severe acute haemolytic anaemia associated with severe methaemoglobinaemia in a G6PD-deficient man

et al. 2018

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Methaemoglobin is a form of haemoglobin in which the ferrous (Fe) ion contained in the iron-porphyrin complex of haem is oxidised to its ferric (Fe) state. Methaemoglobinaemia, the presence of methaemoglobin in the blood, is most commonly treated with methylene blue. However, methylene blue cannot be used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency as it is ineffective in such patients and it can worsen G6PD deficiency haemolysis. We report the case of a 30-year-old man who presented with clinical features of G6PD deficiency-associated haemolysis and was found to have severe methaemoglobinaemia (35%). He was administered blood transfusions and intravenous ascorbic acid. His methaemoglobinaemia resolved within 24 hours. This case demonstrates the successful management of a patient with severe methaemoglobinaemia in the setting of G6PD deficiency haemolysis. Emergency physicians should be aware of the possible co-occurrence of severe methaemoglobinaemia in a patient with G6PD deficiency haemolysis.

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“…Dosing for ascorbic acid in patients with G6PD is 300-1000mg per day orally in divided doses. In most patients, MB is preferred to ascorbic acid because of its rapid onset of action [17,22].…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Treatment of Acute Acquired Methemoglobinemia Following Toxic Ingestion of Ammonium Nitrate in the Setting of Small Bowel Obstruction

Grujich¹,

Romanoff²,

Twelker³

et al. 2017

J Clinic Toxicol

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Methemoglobinemia after ingestion of ammonium nitrate can lead to significant morbidity and mortality in affected patients. Ammonium nitrate is a primary ingredient in synthetic "cold packs," which are used in healthcare as a substitute for bags of ice. Acute or chronic ingestion can have serious consequences to patient health including isosmotic diuresis, metabolic acidosis, circulatory collapse and gastritis. Methemoglobinemia is a result of nitrite toxicity. This toxicity can be compounded by patient comorbidities, which may further complicate treatment. Rapid and accurate diagnosis is essential in the treatment of Methemoglobinemia following ammonium nitrate ingestion.We present the case of a 76 year-old woman who was admitted for small bowel obstruction (SBO) and unintentionally ingested the contents of a cold pack. The patient subsequently became tachycardic, hypotensive, and unresponsive requiring urgent resuscitation and management in the ICU setting. Methemoglobin levels were elevated. The patient was treated with methylene blue (MB) and made a full recovery.

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High-dose vitamin C management in dapsone-induced methemoglobinemia

Cited by 40 publications

References 8 publications

Dapsone Therapy for Pustular Psoriasis: Case Series and Review of the Literature

Dapsone Therapy for Pustular Psoriasis: Case Series and Review of the Literature

Severe acute haemolytic anaemia associated with severe methaemoglobinaemia in a G6PD-deficient man

Evaluation and Treatment of Acute Acquired Methemoglobinemia Following Toxic Ingestion of Ammonium Nitrate in the Setting of Small Bowel Obstruction

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